The way I see it

CCU sister to CCU junior doctor

Fatou Mama Manneh and colleagues describe the career change from nurse to doctor

Deciding to change careers at a mature age is an often daunting decision to make and to follow through.

I was once a sister in the cardiac care unit (CCU) and I am now a junior doctor working in CCU. I still ask myself how I managed this, but what I do know is that it has happened very swiftly and has been surprisingly easy.

My decision to become a doctor was, in part, fuelled by my experiences as a CCU sister. Deciding to change career when I had reached the peak of my nursing career was unnerving. My family, friends, and work colleagues were sceptical, and their scepticism made me sceptical. Yet I was determined to take a gamble. I had numerous hoops to jump through to be eligible to become a medical student but I knew I had the security of a nursing degree to fall back on.

Following the traditional route

It is becoming increasingly common for nurses and other members of the healthcare team to retrain to become doctors. This is being helped by shortened graduate entry courses that recognise people’s previous training and experience and enable them to retrain as doctors, but this was not the route I chose.

I chose to study medicine following the traditional five year programme. The longer programme enabled me to work as a nurse, which helped finance my medical training and maintained my standard of living. Although, quite frankly, I had to take a considerable drop in my standard of living—Heinz baked beans became Tesco’s own brand baked beans. To its credit, though, the five year programme also allowed me to have a life.

I worked in CCU for seven years as a nurse. Initially, as a junior nurse I focused on learning to care for the acutely ill cardiac patient. This was mainly a doing and learning role, a huge part of which included mastering how to interpret electrocardiograms. When I grasped this and acquired managerial skills, I became a CCU sister. This was a more collaborative and supportive role that often made me feel like a watchman, but ensured the safety of patients and staff.

Clinically, my duties included supervising and teaching junior nurses (guiding them through the practical daily management of the patient) and junior doctors (guiding them through the appropriate decision making process for managing patients in such a specialist area).

I remember collaborating with consultant cardiologists to set up algorithms for thrombolysis (remember streptokinase for inferior myocardial infarctions and accelerated rTPA for anterior myocardial infarctions?) When we moved thrombolysis to accident and emergency, we did so reluctantly because the CCU nurses’ critical skill was being taken away. In the advent of primary angioplasty, I remember the resistance and difficulties faced in setting up a primary angioplasty service at my trust.

Becoming a cardiologist

I decided that I wanted to become a cardiologist. Throughout medical school, I was fortunate to have rotations that included cardiology placements. As a student I did not disclose my employment history because I discovered that the response was, “Oh, we don’t need to tell her or teach her because she already knows about it.”

Imagine my delight at discovering that my first job as a junior doctor would be in CCU. On my first day at work, however, I felt as if I had never been in a CCU before. My nerves were compounded by the fact that my fellow house officer was off the ward, and we were short of two senior house officers. So I was on my own.

What did I do all day? I filtered through notes as the registrar assessed and examined patients, and I documented the findings and management plan. I relayed these to the nursing staff after the ward round, filled in the relevant request forms, and ensured the plans were followed through. This is and continues to be my daily routine (in the absence of a more senior doctor I do this on my own).

So what am I doing that is so different? I am focusing on the patients’ clinical problems and making decisions. I am not taking part in managing the patients’ social needs, their daily activities, the tidiness of their beds, and their toileting requirements, but I enquire about these to help direct care.

I initially found my decision making role as a doctor overwhelming. As a nurse or medical student I had the security of being able to check back with the doctor and allow responsibility to lie with him or her. Not any more.

Taking responsibility

Looking back, as a CCU sister, despite all my experience, I still had the security of knowing the ultimate responsibility lay with the doctor. With this, however, came a limitation in the ability to use my knowledge and experience, to make decisions, and to institute a treatment plan. This caused frustration and a desire to move to the other side and become a doctor. With that decision came a certain amount of guilt that I was abandoning someone or something. This “thing” that is somehow untenable.

Previous experience prevented me from telling the CCU nurses I was working with about my background, but when I did, the majority were pleasantly surprised, although some felt the need to try and undermine my decisions. Life experience has made it easier to manage these situations.

Junior CCU doctors often need the help of an experienced CCU nurse to help them negotiate the intricacies of managing CCU patients. I am in the fortunate position of being able to amalgamate the two. Although I encounter the same horrific workload as my colleagues, my history makes life easier for me as I can make decisions more confidently. Also, I know nurses’ priorities, so I understand how to have the best working relationship with them.